title: Enhanced characterization of ventricular performance after coarctation repair in neonates and young children.
abstract: BACKGROUND
  Within the group of patients undergoing coarctectomy today, two subgroups can be identified: neonates with a critical coarctation and nonneonatal patients. We hypothesize that patients who have to undergo repair in the neonatal period will have more persistent impairment of ventricular performance postoperatively. Accordingly, we aimed to characterize biventricular performance after coarctectomy in neonatal and nonneonatal patients.
  
  
  METHODS
  Children (aged 0 to 17 years) undergoing a coarctectomy were prospectively included and classified as neonatal (<1 month old) or nonneonatal patients. Age-matched controls were included for each measurement occasion. To evaluate left (LV) and right ventricular (RV) performance, fractional shortening, peak systolic (S') and early diastolic (E') tissue Doppler imaging velocities, and E/E' were assessed preoperatively, at discharge, and 1 year postoperatively (11.4 ± 8.3 months).
  
  
  RESULTS
  In neonatal (n = 18) and nonneonatal (n = 19) patients LV performance significantly improved within the first postoperative year. Yet 1 year postoperatively, LV S' was still lower in neonatal patients vs controls (4.8 ± 1.1 vs 6.1 ± 1.6 cm/s; p = 0.036), whereas comparable results were observed in nonneonatal patients and controls. One year postoperatively, LV diastolic performance was impaired in neonatal (LV E' 8.7 ± 3.1 vs 13.2 ± 3.9 cm/s, p = 0.005) and nonneonatal patients (LV E' 12.1 ± 3.5 vs 15.1 ± 2.4 cm/s, p = 0.008) vs controls. In RV performance variables, no differences were observed 1 year postoperatively between neonatal and nonneonatal patients and controls.
  
  
  CONCLUSIONS
  In both subgroups, LV diastolic performance does not recover to normal values within the first postoperative year. However, LV systolic performance remains more persistently impaired in patients who have to undergo repair in the neonatal period vs nonneonatal repair.
authors.affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Liselotte M
authors.initials: LM
authors.lastname: Klitsie
authors.forename: Arno A W
authors.initials: AA
authors.lastname: Roest
authors.forename: Irene M
authors.initials: IM
authors.lastname: Kuipers
authors.forename: Annelies E
authors.initials: AE
authors.lastname: Van der Hulst
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.forename: Nico A
authors.initials: NA
authors.lastname: Blom
authors.forename: Arend D J
authors.initials: AD
authors.lastname: Ten Harkel
mesh_terms: D000293:Adolescent; D001017:Aortic Coarctation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D016276:Ventricular Function
keywords: 20; E; E'; FS; LV; LVIDd; LVIDs; LVMI; Left ventricle internal diameter at end-diastole; Left ventricle internal diameter at end-systole; RV; S'; SD; TDI; V(max); aortic peak instantaneous velocity at the previous coarctation site; early diastolic tissue Doppler imaging velocity; fractional shortening; indexed left ventricular mass; left ventricle; peak early wave Doppler flow velocity; right ventricle; standard deviation; systolic tissue Doppler imaging velocity; tissue Doppler imaging